"First" Lobotomy Performed

“On this day in 1935, in a Lisbon hospital, medical history was made, as the Portuguese neurologist Antonio Egas Moniz performed the first modern frontal lobotomy, known at the time as a leucotomy.

Cranial surgery was nothing new, and has in fact been practiced around the world for thousands of years. The process is called trepanation (or trephination), which means to “”bore”” in Greek. The oldest trepanned (drilled or carved) skull was discovered in the Ukraine in 1966 and dates between 7,620-8,020 years ago. Archaeologists have suggested that some cultures used the procedure to release evil spirits. In pharaonic Egypt, trepanning was possibly considered to ease the transport of a pharaoh’s soul after death. In ancient Greece, Hippocrates (c. 460 to 355 BC) recommended trepanning for head wounds. Roman Syrians thought “”opening the brain and removing worms”” could cure blindness.

Although more modern than ancient trepanning, in the context of neural surgery as we know it today, Antonio Egas Moniz’s operation was still exceedingly crude. Two holes were drilled into the patient’s cranium, and an alcohol solution was injected into the frontal lobe. The alcohol acted as a bleaching agent, attacking the soft tissue at the front of the brain, and thus altering the behaviour of the patient. Moniz furthered his research to include the cutting away of white matter at the front of the brain with a specially designed instrument, the leucotome.

Moniz operated on a total of 21 patients, with varying psychological disorders, before presenting his findings to the medical world in 1936. He concluded that the procedure was largely beneficial to the patient, but conceded that those with advanced disorders did not improve. While some were skeptical, Moniz’s conclusions lead to extensive research into psychosurgery across the globe.

The procedure, which became known as the frontal lobotomy, was soon refined, and became a regular course of treatment in the cases of acute psychiatric disorders. It became common practice, especially in America, to treat neurological conditions with direct brain surgery, with disorders such as schizophrenia and clinical depression proving particular targets.

Moniz was presented with the Nobel Prize for Medicine in 1949, but already the benefits of the lobotomising procedure were being called into doubt. While there was little doubt that the lobotomy has an effect on the behavior of a patient, there was much dispute as to the moral legitimacy of the treatment. There was mounting concern about the number of patients who were irrevocably damaged by the procedure, with countless cases of patients being reduced to a permanent vegetative state. In the Soviet Union, the practice was deemed “”contrary to the principles of humanity,”” and a ban was introduced as early as 1950, with many other countries following suit.

But despite the misgivings of many in the mental health professions, the practice remained in use, albeit sparingly, in the United Kingdom and the United States until the late 1970s. In 1977, prompted by increased criticism of the procedure, the U.S. Congress created the National Committee for the Protection of Human Subjects of Biomedical and Behavioural Research. The body investigated the effectiveness and long-term impact of the procedure, as well as accusations that the treatment was used to subdue and subjugate the vulnerable and the marginalised. While it was recognised that the procedure could produce positive effects, the overall conclusions of the Committee were that psychosurgery was only beneficial in a small number of specific cases, and should be utilised only after all medical alternatives had been exhausted.”

Credit: Corbis 42-18591505 Caption: Cranial surgery had existed for centuries, but Moniz took one step further in what became known as the lobotomy.